Navigating the Health Care System

Advice Columns from Dr. Carolyn Clancy

Former AHRQ Director Carolyn Clancy, M.D., prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan.

Jan162008

What to Ask Before Surgery

By Carolyn M. Clancy, M.D.

If you are facing surgery, you are not alone. Every year, more than 15 million Americans have surgery.

Popular TV shows would have you believe that surgery is always an immediate, life-or-death matter. In reality, most operations are not emergencies.

This means you have time to learn about the surgery your doctor has recommended so you understand what's involved and feel comfortable that it's the best treatment. It also means you have time to find the right surgeon and hospital and to ask your surgeon questions to make sure the operation is as safe as possible.

Most likely, the doctor you see for general medical care is your primary care doctor. He or she may be the doctor who recommends you have surgery and refers you to a surgeon. You may want to find an additional surgeon to get a second opinion to confirm an operation is the right treatment for you.

My agency, the Agency for Healthcare Research and Quality (AHRQ), has developed a list of questions you can ask your primary care doctor and surgeon before you have surgery. We also give reasons for asking these questions. The answers you get will help you make the best decision about your treatment and be as prepared as possible.

Ask your doctor to explain:

Why you need to have surgery. There are many reasons to have surgery: to relieve or prevent pain, reduce a symptom of a problem, improve the way your body functions, or even save your life. Make sure you understand how the operation your doctor has suggested will improve your medical condition.

What kind of operation he or she is recommending. Ask your surgeon to explain the surgery and how it is done. Your surgeon can draw a picture or a diagram and explain the steps involved in the surgery. Ask if there is more than one way of doing the operation. For example, some operations that once required large incisions now can be performed using much smaller incisions. For some surgeries you need to stay in the hospital for 1 day or longer, but for others it is possible for you go home on the same day.

If there are alternatives to surgery. Depending on your condition, surgery may not be the only answer to a medical problem. Medicines or treatments, such as special exercises or changes in diet, could give you the same—or even better—results as surgery.

The benefits of the operation. Ask your surgeon to explain what you will gain by having the operation. If you need a hip replacement, for example, you may be able to walk without pain after the surgery. Ask how long the benefits will last. In some cases, you may need another operation after a short time for the benefits to continue. In other cases, the benefits of the surgery may last your lifetime.

The risks of the operation. All operations have some risk. That's why it is important to balance the benefits of the operation with the risk of complications or side effects. Typical complications include infection, too much bleeding, accidental injury, or reaction to anesthesia. Ask your doctor to explain what side effects you might have, such as swelling or soreness around the incision. Find out what steps the doctors and nurses will take to control any pain you may feel after surgery.

What will happen if you don't have this operation. Based on what you learn about the benefits and the risks of the operation, you may decide not to have it. Ask your surgeon what you stand to lose—or gain—by not having the operation now. Will you be in more pain in the future? Could your condition get worse? Could the condition get better on its own?

How much the operation will cost. Call your health insurance company before you have the operation. Even with insurance, there may be costs that you will have to pay, depending on the hospital and surgeon you use. You will also get a bill from the hospital for your care and from the other doctors who took care of you during your hospital stay. If you don't have health insurance, talk to the hospital's billing staff and your surgeon to see if you can get a discount on the cost of the operation.

Even though millions of operations are performed each year, surgery is a big decision for every patient. Take the time you need to ask questions before you undergo surgery. When you are well-informed about your treatment, the chances are better that you will be more satisfied with the results.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.